The Gold plan is second from the top (Platinum) and above the two other Metallic plans (Silver and Bronze) so in theory, it should equate to an upper tier plan on the current market. In fact, the Gold plan is much richer than anything we had on the market before. Keep in mind that each carrier might have small adjustments up or down to the core benefits but only by a few percentage points by law. A link to the actual benefits will be below through the quote.
This was our biggest surprise when looking at the California Gold Plan benefits originally. It was still (same with Platinum) a no-deductible plan. We fully expected a $250-500 deductible which is richer than anything we had on the individual family market (although in line with Group's richest plans). We haven't had PPO no deductible plans on the individual family market for almost 10 years now due to the cost.
The second most important piece of a health plan is the OOP or Out of Pocket max which describes a plan's protection from the really big bills. The Gold Plan OOP is $6200. The plan works as 80/20 plans (you pay 20% till OOP). Keep in mind that one night in a hospital can be $20-30K so the plans will likely have big hits unless it is wrapped in the HMO model's cost containment ability.
The Gold plan with have a $45 copay for primary care visits and a $65 for specialist. Preventative benefits will be covered at 100% (as with current plans) in-network. For presciptions, Generic copays are $19, Brand formulary are $50, and Brand non-formulary are $70. There is no deductible for medications which is a huge departure from current health plans.
Diagnostic Lab will have a $30 copay. X-ray will have a $50 copay. Imaging (think MRI's, Cat Scans, etc) will have a 20% coinsurance or $250 copay depending on the plan selection.
It all comes down to price and health. That's going to be tough for the Platinum and Gold which are both much richer than what anyone buys today on the market. There's a reason those plans don't exist now in the market. If you can save $2K annually by adding $2K to your deductible, most people will take that trade-off. Only the unhealthy will now which furthers that price spread into future years. We see limited uptake by the public for the Platinum or Gold and see the Silver (subsidy) and Bronze plans dominate the California Exchange market with 90%+ share.
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|Single Person:||$16k - $23k|
|2 People||$22k - $31k|
|3 People||$27k - $39k|
|4 People||$33k - $47k|
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